#ecuimres transcript

Healthcare Social Media Transcript

From: Fri Sep 28 0:00:00 PDT 2012
To: Fri Sep 28 8:00:00 PDT 2012

What is #ecuimres? Who were the influencers during this time period? #ecuimres analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

nephondemand
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#ecuimres #grandrounds 9/28: Keith Scott will present "Topics in Neurocritical Care". Will tweet live. Speaker profile: http://t.co/70q35Iy2
nephondemand
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#ecuimres #grandrounds 9/28: Audience participation is requested. Follow link: http://t.co/jPUfVVhc
nephondemand
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#ecuimres #grandrounds 9/28: title slide http://t.co/Ocxy5op4
nephondemand
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#ecuimres 9/28: no recording of #grandrounds today as per the desire of the speaker :( http://t.co/yVsQbkq9
MedPedsDoctor
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#ecuimres gr8 to see that another institution is tweeting Grand Rounds. #meded
nephondemand
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#ecuimres #grandrounds 9/28: topics to discuss today= status epilepticus, SAH, bleeding p tpa, & brain dysfxn in severe illness
ecuimchiefs
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#ecuimres #grandrounds First topic: Status Epilepticus. Dr Scott feels this is a disorder that under treated (effectively).
ecuimchiefs
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#ecuimres #grandrounds Defined: seizure activity >5 minutes (previously >30 mins).
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus defined as lasting >5 minutes. Almost all sz's resolve within 5 min
ecuimchiefs
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#ecuimres #grandrounds Classified as: convulsive, non-convulsive, refractory (despite 2 anti epileptics).
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus classified into 3 groups: convulsive, non-convulsive, refractory (in spite of 2 AE drugs)
ecuimchiefs
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#ecuimres #grandrounds early phase of seizure = GABA dependent. Therefore use GABA agonist early!
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus the GABAnergic phase is the best time to intervene -- lasts 4 ~1 hr http://t.co/LaLgufqJ
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus after GABAnergic phase you enter the therapeutic resistance phase, mediated by glutamate
ecuimchiefs
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#ecuimres #grandrounds Status with convulsions has better prognosis than status without convulsions.
ecuimchiefs
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#ecuimres #grandrounds Goal of therapy is to stop the SEIZING, not the convulsions.
nephondemand
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RT @ecuimchiefs: #ecuimres #grandrounds Status w/convulsions has better prognosis than status w/o convulsions b/c u identify the sz sooner
ecuimchiefs
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#ecuimres #grandrounds New treatment paradigm: Initial therapy, Urgent control therapy, Refractory therapy.
ecuimchiefs
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#ecuimres #grandrounds Emergent: use benzos (extensive clinical experience). ie: IV lorazepam or IM midazolam
ecuimchiefs
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#ecuimres #grandrounds (or rectal diazepam)
nephondemand
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#ecuimres #grandrounds 9/28: #epilepticus 1st line therapy r GABA agonists = BDZs but evidence is Class III; IV Ativan, IM versed, PR valium
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus optimal initial dose = ativan 0.1 mg/kg upto 4 mg; repeat in 5 min; biggest fear is...
ecuimchiefs
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#ecuimres #grandrounds Lorazepam dosing: 0.1mg/kg. So 80 kg man --> 8mg. But neurocritical care society recommends max 4mg.
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus ...conversion from convulsive 2 nonconvulsive; this is the biggest problem w/underdosing
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus mortality increases when pt goes from convulsive to nonconvulsive status
ecuimchiefs
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#ecuimres #grandrounds Fear of under dosing status epilep is conversion from convulsive SE to non-convulsive SE (remember: worse prognosis)
nephondemand
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#ecuimres #grandrounds 9/28: #epilepticus best way 2 tell if pt is in nonconvulsive status: does he have interpretation of his environment?
buyativanonline
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#ecuimres #grandrounds 9/28: #status #epilepticus optimal initial dose = ativan 01 mg/kg upto 4... Buy Ativan Online -> http://t.co/HHzfXFoD
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus recommended dosages of midazolam IM or Valium PR. See pic http://t.co/wWinoazO
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus other recd drugs and their dosages; see pic http://t.co/K6XpxZEk
ecuimchiefs
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#ecuimres #grandrounds Patients treated with benzos actually suffered LESS resp suppression (intubation) than placebo. http://t.co/igvDCOB4
ecuimchiefs
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#ecuimres #grandrounds Some evidence suggests valproate may have advantage over phenytoin: http://t.co/YFnQmZMU
ecuimchiefs
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#ecuimres #grandrounds If seizure activity >1 hour, pt is likely in Resistance phase of status.
ecuimchiefs
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#ecuimres #grandrounds Refractory drugs = continuous infusions (midazolam, propofol, pentobarbital).
ecuimchiefs
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#ecuimres #grandrounds we don't really use pentobarbital/phenobarbital anymore. Almost 100% develop VAP (has to do w/ WBC signaling).
ecuimchiefs
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#ecuimres #grandrounds After we've stopped a pts convulsions, why do we NOT monitor after via EEG to ensure seizure-free status?
ecuimchiefs
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#ecuimres #grandrounds Dr Scott asks why can we all read EKG to determine MI or not, but not do the same for EEG readings?
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus if convulsive, 30d mortality 19-27%, 90d is 19%;
ecuimchiefs
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#ecuimres #grandrounds Convulsive SE mortality: only 9-21% to hosp discharge, 30 days 19-27%.
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus convulsive morbidity: 11-16% have cognitive sequalae; 26% have some decline in fxnl status
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus delayed therapy for convulsive sz (1 hr) leads 2 mortality of ~45%
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus nonconvulsive 30d mortality 65% (die from cerebral edema), 90d mortality = no data
ecuimchiefs
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#ecuimres #grandrounds 8% vs 45% mortality if not treated within 1 hour.
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus nonconvulsive mortality =10% if sz lasts <10 hr; >10 hr, 85% mortality!
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus nonconvulsive morbidity- only 39% return to baseline at 3 months
nephondemand
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#ecuimres #grandrounds 9/28: #status #epilepticus the biggest take home point today : •TIME IS BRAIN•
nephondemand
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#ecuimres #grandrounds 9/28: moving on to SAH now
nephondemand
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#ecuimres #grandrounds 9/28: bleeding p #TPA tranexamic acid investigated as a thrombotic agonist 1.5-6g qd x 3w; good data from @bmj_latest
ecuimchiefs
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#ecuimres #grandrounds BP goals in ICH: no concrete data to guide us!
nephondemand
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#ecuimres #grandrounds 9/28: brain in critical illness #vagus nerve is really susceptible to inflammation, causing NT changes in brain

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